Treatment Overview
Rubber band ligation is a procedure in which
the hemorrhoid is tied off at its base with rubber bands, cutting off the blood
flow to the hemorrhoid. This treatment is only for internal hemorrhoids.
To do this procedure, a doctor inserts
a viewing instrument (anoscope) into the anus. The hemorrhoid is grasped with
an instrument, and a device places a rubber band around the base of the
hemorrhoid. The hemorrhoid then shrinks and dies and, in about a week, falls
off.
A scar will form in place of the hemorrhoid, holding nearby
veins so they don't bulge into the anal canal.
The procedure is
done in a doctor's office. You will be asked whether the rubber bands feel too
tight. If the bands are extremely painful, a medicine may be injected into the
banded hemorrhoids to numb them.
After the procedure, you may feel
pain and have a sensation of fullness in the lower abdomen. Or you may feel as
if you need to have a bowel movement.
Treatment is limited to 1 to
2 hemorrhoids at a time if done in the doctor's office. Several hemorrhoids may
be treated at one time if the person has general anesthesia. Additional areas may
be treated at 4- to 6-week intervals.
What To Expect After Treatment
People respond differently to this
procedure. Some are able to return to regular activities (but avoid heavy
lifting) almost immediately. Others may need 2 to 3 days of bed rest.
- Pain is likely for 24 to 48 hours after rubber
band ligation. You may use acetaminophen (for example, Tylenol) and sit in a
shallow tub of warm water (sitz bath) for 15 minutes at a time to relieve
discomfort.
- To reduce the risk of bleeding, avoid taking aspirin
and other
nonsteroidal anti-inflammatory drugs (NSAIDs) for 4 to
5 days both before and after rubber band ligation.
- Bleeding may
occur 7 to 10 days after surgery, when the hemorrhoid falls off. Bleeding is
usually slight and stops by itself.
Doctors recommend that you take stool
softeners containing fiber and drink more fluids to ensure smooth bowel
movements. Straining during bowel movements can cause hemorrhoids to come
back.
Why It Is Done
Rubber band ligation is the most
widely used treatment for internal hemorrhoids. If you still have symptoms after three
or four treatments, surgery may be considered.
Rubber band
ligation cannot be used if there is not enough tissue to pull into the banding
device. This procedure is almost never appropriate for
fourth-degree hemorrhoids.
How Well It Works
Rubber band ligation works for about 8 out of 10 people. People who have this treatment are less likely to need another treatment compared to people who have coagulation treatments. About 1 out of 10 people may need surgery.footnote 1
Risks
Side effects are rare but include:
- Severe pain that does not respond to the
methods of pain relief used after this procedure. The bands may be too close to
the area in the anal canal that contains pain sensors.
- Bleeding
from the anus.
- Inability to pass urine (urinary
retention).
- Infection in the anal area.
What To Think About
Rubber band ligation is considered to be
the most effective nonsurgical treatment for internal hemorrhoids over the long
term. Because this treatment can be painful, some people might not choose it.
Although a different treatment might be less painful, it may not work as well. And a less effective treatment may need to be repeated for recurring
hemorrhoids.
Surgical removal of hemorrhoids (hemorrhoidectomy) may provide better
long-term results than fixative procedures such as rubber band ligation. But
surgery is more expensive, requires longer recovery times, and has a greater
risk of complications.
Not all doctors have the experience or the
equipment needed to do rubber band ligation. This may help you decide which procedure
to choose. Ask your doctor which procedure he or she has done the most, how
many times he or she has done the procedure, and how satisfied patients have
been with the outcome.
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
References
Citations
- American Gastroenterological Association (2004). American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology, 126(5): 1463-1473.
Credits
ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Specialist Medical ReviewerKenneth Bark, MD - General Surgery, Colon and Rectal Surgery